Identifying Indicators of Readiness and Capacity for Implementing Farm-to-School Interventions.

BACKGROUND: Farm-to-school interventions are recommended strategies to improve dietary behaviors among school-aged children. Tools are needed to assess community readiness and capacity to optimize farm-to-school implementation. The objective of this study was to identify and prioritize factors to inform tailored farm-to-school implementation by practitioners working in diverse contexts. METHODS: Practitioners and community residents (N = 194) participated in semistructured interviews (N = 18) and focus groups (N = 23). Thematic analysis was conducted to identify themes and subthemes influencing farm-to-school implementation. The subthemes were operationalized into measureable indicators. The themes and their associated indicators were prioritized through a consensus conference with an expert panel (N = 18). RESULTS: The qualitative data analysis and consensus conference yielded 4 themes and 17 indicators associated with community readiness and capacity to implement farm-to-school. The themes represent school capacity, networks and relationships, organizational and practitioner capacity, and community resources and motivations. CONCLUSIONS: Findings highlight a range of indicators of community readiness and capacity needed to support farm-to-school implementation. Results offer guidance for tailoring intervention delivery based on levels of community, school, practitioner, and organizational readiness and capacity.

Indicators of Readiness and Capacity for Implementation of Healthy Eating Strategies in Child Care Settings Serving Low-Income Children.

OBJECTIVE: Identify factors perceived to influence implementation of healthy eating policy, systems, and environmental strategies (PSEs) in child care settings serving low-income children. DESIGN: This mixed-methods study, conducted in 2015-2016, used semi-structured interviews (n = 18), focus groups (n = 23), and an expert panel. PARTICIPANTS: Public health (n = 11) and Supplemental Nutrition Assistance Program-Education practitioners (n = 9) and community residents (n = 174) from 9 counties in Ohio. Expert panelists (n = 10) had experience implementing PSEs in child care settings. PHENOMENON OF INTEREST: Implementation factors influencing healthy eating PSEs in child care settings. ANALYSIS: Qualitative thematic analysis of 41 transcripts using a grounded theory approach. Indicators for each theme were operationalized. Consensus feedback from an expert panel weighted themes and indicators based on perceived importance for implementation. RESULTS: Identified themes relevant to implementation of PSEs included (1) organizational and practitioner capacity, (2) child care capacity, (3) networks and relationships, and (4) community resources and motivations. Nineteen indicators related to the 4 themes were identified and weighted. CONCLUSIONS AND IMPLICATIONS: Findings highlighted key factors within domains of influence and informed the operationalization of the indicators and the development of an assessment tool. The assessment tool is designed to tailor PSE implementation to the realities of different child care settings.

Predictors of Farmers' Market Shopping among People Receiving Supplemental Nutrition Assistance Program Benefits.

Promoting use of farmers' markets (FMs) is a promising community-level strategy to increase access to nutritious foods such as fruits and vegetables. Yet, FM shopping among people with Supplemental Nutrition Assistance Program (SNAP) benefits remains low. This research examined predictors of FM shopping among SNAP recipients living within 1 mile of a FM. A cross-sectional survey of SNAP participants (N = 270) was conducted in 2015 in Cleveland and East Cleveland, OH, USA. Multinomial regression and zero-truncated Poisson regression analyses were conducted to examine factors associated with FM shopping. Results indicate 48% reported shopping at a FM at least once in the past year, 26% had shopped at a FM before, but not in the last year, and 26% had never shopped at a FM. The multivariable analyses found awareness of FMs and a healthy food incentive program, and four dimensions of healthy food access are significantly associated with FM shopping among SNAP recipients. The food access dimensions included service delivery, spatial-temporal, personal, and social access. Findings highlight modifiable leverage points for improving the reach of FMs among low-income populations.

Consensus modeling to develop the farmers' market readiness assessment and decision instrument.

Nutrition-related policy, system, and environmental (PSE) interventions such as farmers' markets have been recommended as effective strategies for promoting healthy diet for chronic disease prevention. Tools are needed to assess community readiness and capacity factors influencing successful farmers' market implementation among diverse practitioners in different community contexts. We describe a multiphase consensus modeling approach used to develop a diagnostic tool for assessing readiness and capacity to implement farmers' market interventions among public health and community nutrition practitioners working with low-income populations in diverse contexts. Modeling methods included the following: phase 1, qualitative study with community stakeholders to explore facilitators and barriers influencing successful implementation of farmers' market interventions in low-income communities; phase 2, development of indicators based on operationalization of qualitative findings; phase 3, assessment of relevance and importance of indicators and themes through consensus conference with expert panel; phase 4, refinement of indicators based on consensus conference; and phase 5, pilot test of the assessment tool. Findings illuminate a range of implementation factors influencing farmers' market PSE interventions and offer guidance for tailoring intervention delivery based on levels of community, practitioner, and organizational readiness and capacity.